Prenatal exposure to alcohol can increase the risk for lifelong neurobehavioral problems, as well as developmental disabilities that fall under the umbrella term of fetal alcohol spectrum disorders (FASD). Poor sensorimotor function, specifically balance deficits, is one area of neurodevelopmental impairment described among children with FASD. Efficient balance and postural control are important foundations for engagement in higher level functional skills such as maintaining attention, navigating an environment, controlling complex movements, and participating in childhood activities that promote physical and behavioral health and development. Balance is a complex process involving the integration sensory information and the coordination of neuromuscular responses. Despite evidence that balance deficits are problematic among children with FASD and preliminary reports that poor sensorimotor integration is suspect, the nature of these balance and postural control deficits are not fully understood. Nor have interventions to improve daily function and behavior through the remediation of underlying sensorimotor deficits been considered and tested among this population, Yet, evidence from alcohol exposed animal models indicates the capacity for neural plasticity, motor learning, and improved motor performance following complex rehabilitative training. Therefore, the overarching goal of this combined R21/R33 proposal is to determine the preliminary effectiveness of a sensorimotor intervention to improve balance and related functional and behavioral outcomes among children with FASD. Our proposed intervention will employ the use of virtual reality computer technology to train the ability to weight and reweight sensory information during balance perturbations invoked by simulated conditions of sensory conflict. As a first step, this research (R21) proposes to more fully describe balance impairments and subsequent functional impact of sensorimotor problems in children with FASD. This will be done by comparing the performance of children with FASD ages 7.0-14.9 years to a matched group of children with typical development on a battery of clinical tests and a novel assessment system that specifically examines how visual, vestibular and somatosensory information is used during balance. This data will shape the development of our proposed sensorimotor intervention technology and preliminary intervention protocol, which will be tested with a small group of children with FASD to gauge initial feasibility and responsiveness. Data from the R21 will lay the groundwork for the next phase of research (R33) that aims to refine the sensorimotor training for balance intervention technology and establish and test the effectiveness of the intervention delivered via a short-term intensive laboratory protocol or a longer term home-based protocol. Collectively, these studies lay the essential groundwork for a larger multisite efficacy study to determine the effectiveness of the intervention with a larger sample of children with FASD and other groups of children with neurodevelopmental disabilities. PUBLIC HEALTH RELEVANCE: The development and preliminary evaluation of a new sensorimotor training to affect balance, engagement and learning will address specific gaps in the understanding, diagnosis and treatment of balance disorders in children with fetal alcohol spectrum disorders (FASD). Given proof of concept, safety, feasibility, tolerability and preliminary effectiveness, the sensorimotor training for balance intervention can be used to improve the sensory component of postural control, that in turn will improve functional balance, movement, engagement and learning in children with FASD and other developmental disorders with similar balance deficits.